{"title":"幽门肉毒杆菌毒素治疗糖尿病性胃轻瘫：一例持续血糖改善。","authors":"Luke Bugeja, Lianne Camilleri, John Schembri","doi":"10.12890/2025_005495","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Diabetic gastroparesis is a gastrointestinal motility disorder defined as a delay in gastric emptying time without any mechanical obstruction. This affects about 40% of patients with type 1 diabetes and up to 30% of patients with type 2 diabetes, especially those with long-standing disease, and arises from dysfunction of the autonomic and enteric nervous systems. Unfortunately, it can cause great difficulty in controlling post-meal glucose excursions because food absorption can become unpredictable in this group of patients. Gastroparesis is therefore linked with fluctuations in glycaemic control due to variable nutrient absorption. This may worsen the extent of gastroparesis, making glucose control even more difficult. Treatment with botulinum toxin injections has been described in clinical trials with doubtful efficacy to abating symptoms associated with gastroparesis.</p><p><strong>Case presentation: </strong>We report a case of how pyloric botulinum toxin injections significantly improved a patient's type 1 diabetic control and gastrointestinal symptoms associated with gastroparesis and is still maintaining improved glucose levels six months after her procedure. Although current data and case studies highlight a potential role for pyloric botulinum toxin injections, no association was found between pyloric botulinum toxin injections and blood glucose control in type 1 diabetics.</p><p><strong>Conclusion: </strong>This article examines a potential promising association between botulinum toxin injection in the pylorus and enhanced diabetic control in type 1 diabetics.</p><p><strong>Learning points: </strong><i>Long-lasting effect:</i> Despite being a temporary intervention, pyloric botulinum toxin injection provided sustained clinical benefit in this case.<i>Glycaemic impact:</i> The treatment significantly improved glucose control and symptoms of autonomic neuropathy in a type 1 diabetic patient.<i>Future potential:</i> Current data lack evidence for glycaemic benefit in type 1 diabetics, highlighting the need for targeted clinical trials.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 8","pages":"005495"},"PeriodicalIF":0.0000,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12331266/pdf/","citationCount":"0","resultStr":"{\"title\":\"Pyloric Botulinum Toxin for Diabetic Gastroparesis: A Case of Sustained Glycaemic Improvement.\",\"authors\":\"Luke Bugeja, Lianne Camilleri, John Schembri\",\"doi\":\"10.12890/2025_005495\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Diabetic gastroparesis is a gastrointestinal motility disorder defined as a delay in gastric emptying time without any mechanical obstruction. This affects about 40% of patients with type 1 diabetes and up to 30% of patients with type 2 diabetes, especially those with long-standing disease, and arises from dysfunction of the autonomic and enteric nervous systems. Unfortunately, it can cause great difficulty in controlling post-meal glucose excursions because food absorption can become unpredictable in this group of patients. Gastroparesis is therefore linked with fluctuations in glycaemic control due to variable nutrient absorption. This may worsen the extent of gastroparesis, making glucose control even more difficult. Treatment with botulinum toxin injections has been described in clinical trials with doubtful efficacy to abating symptoms associated with gastroparesis.</p><p><strong>Case presentation: </strong>We report a case of how pyloric botulinum toxin injections significantly improved a patient's type 1 diabetic control and gastrointestinal symptoms associated with gastroparesis and is still maintaining improved glucose levels six months after her procedure. Although current data and case studies highlight a potential role for pyloric botulinum toxin injections, no association was found between pyloric botulinum toxin injections and blood glucose control in type 1 diabetics.</p><p><strong>Conclusion: </strong>This article examines a potential promising association between botulinum toxin injection in the pylorus and enhanced diabetic control in type 1 diabetics.</p><p><strong>Learning points: </strong><i>Long-lasting effect:</i> Despite being a temporary intervention, pyloric botulinum toxin injection provided sustained clinical benefit in this case.<i>Glycaemic impact:</i> The treatment significantly improved glucose control and symptoms of autonomic neuropathy in a type 1 diabetic patient.<i>Future potential:</i> Current data lack evidence for glycaemic benefit in type 1 diabetics, highlighting the need for targeted clinical trials.</p>\",\"PeriodicalId\":11908,\"journal\":{\"name\":\"European journal of case reports in internal medicine\",\"volume\":\"12 8\",\"pages\":\"005495\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-07-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12331266/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European journal of case reports in internal medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.12890/2025_005495\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European journal of case reports in internal medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.12890/2025_005495","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
Pyloric Botulinum Toxin for Diabetic Gastroparesis: A Case of Sustained Glycaemic Improvement.
Introduction: Diabetic gastroparesis is a gastrointestinal motility disorder defined as a delay in gastric emptying time without any mechanical obstruction. This affects about 40% of patients with type 1 diabetes and up to 30% of patients with type 2 diabetes, especially those with long-standing disease, and arises from dysfunction of the autonomic and enteric nervous systems. Unfortunately, it can cause great difficulty in controlling post-meal glucose excursions because food absorption can become unpredictable in this group of patients. Gastroparesis is therefore linked with fluctuations in glycaemic control due to variable nutrient absorption. This may worsen the extent of gastroparesis, making glucose control even more difficult. Treatment with botulinum toxin injections has been described in clinical trials with doubtful efficacy to abating symptoms associated with gastroparesis.
Case presentation: We report a case of how pyloric botulinum toxin injections significantly improved a patient's type 1 diabetic control and gastrointestinal symptoms associated with gastroparesis and is still maintaining improved glucose levels six months after her procedure. Although current data and case studies highlight a potential role for pyloric botulinum toxin injections, no association was found between pyloric botulinum toxin injections and blood glucose control in type 1 diabetics.
Conclusion: This article examines a potential promising association between botulinum toxin injection in the pylorus and enhanced diabetic control in type 1 diabetics.
Learning points: Long-lasting effect: Despite being a temporary intervention, pyloric botulinum toxin injection provided sustained clinical benefit in this case.Glycaemic impact: The treatment significantly improved glucose control and symptoms of autonomic neuropathy in a type 1 diabetic patient.Future potential: Current data lack evidence for glycaemic benefit in type 1 diabetics, highlighting the need for targeted clinical trials.
期刊介绍：
The European Journal of Case Reports in Internal Medicine is an official journal of the European Federation of Internal Medicine (EFIM), representing 35 national societies from 33 European countries. The Journal''s mission is to promote the best medical practice and innovation in the field of acute and general medicine. It also provides a forum for internal medicine doctors where they can share new approaches with the aim of improving diagnostic and clinical skills in this field. EJCRIM welcomes high-quality case reports describing unusual or complex cases that an internist may encounter in everyday practice. The cases should either demonstrate the appropriateness of a diagnostic/therapeutic approach, describe a new procedure or maneuver, or show unusual manifestations of a disease or unexpected reactions. The Journal only accepts and publishes those case reports whose learning points provide new insight and/or contribute to advancing medical knowledge both in terms of diagnostics and therapeutic approaches. Case reports of medical errors, therefore, are also welcome as long as they provide innovative measures on how to prevent them in the current practice (Instructive Errors). The Journal may also consider brief and reasoned reports on issues relevant to the practice of Internal Medicine, as well as Abstracts submitted to the scientific meetings of acknowledged medical societies.
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